Optimization of an Instrument for Screening Complicated Grief After Reproductive Loss

OBJECTIVE: To determine the optimal wording for development of an instrument to screen for complicated grief after reproductive loss (Reproductive Grief Screen [RGS]). DESIGN: This study used a cross-sectional survey design. SETTING: Participants were recruited throughout the United States to complete an online REDCap (Research Electronic Data Capture) or Qualtrics survey. PARTICIPANTS: Survey respondents included 844 women who had one or more previous spontaneous or induced losses (regardless of gestational age) after January 1, 2017. METHODS: Survey participants assessed three possible ways of rewording three items in an online survey. In addition to completing a permutation of the RGS, respondents ranked the wording of each of the RGS items and completed the Arousal Adjective Checklist and the Reactions to Research Participation Questionnaire (RRPQ) to assess possible negative effects of the version of the RGS they received. RESULTS: There were no significant differences among the three possible ways to word two of the items using women's rating of the wording or the Arousal Adjective Checklist or the RRPQ. However, linear regression did demonstrate that across all permutations of the RGS, women who received the third version of one item reported greater negative symptoms using the RRPQ. The third iteration of one item in the RGS is suboptimal, suggesting that either the original wording or the second formulation is preferred by the target population. Participants were grateful to be asked about their reproductive losses and overwhelmingly rated all items as acceptable. CONCLUSION: When combined with other data previously published by this research team that suggested preferred wording for other items, a single preferred form of the RGS is now defined.